Healthcare Provider Details

I. General information

NPI: 1649559394
Provider Name (Legal Business Name): PROMEDICA NORTHWEST OHIO CARDIOLOGY CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2011
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 N MCCORD RD STE 101
TOLEDO OH
43615-1753
US

IV. Provider business mailing address

2940 N MCCORD RD
TOLEDO OH
43615-1753
US

V. Phone/Fax

Practice location:
  • Phone: 419-842-3000
  • Fax: 419-942-3042
Mailing address:
  • Phone: 419-842-3000
  • Fax: 419-942-3042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC3500X
TaxonomyCardiac Rehabilitation Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0404X
TaxonomyCardiac Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TANYA WINES
Title or Position: DIRECTOR
Credential:
Phone: 567-585-0422